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Biomedical subjects

D Federman

Publications and source records attributed to D Federman.

12 recordsLinked to original sources
PubMed2001

Common bacterial skin infections.

Skin infections account for a significant portion of dermatologic disease, often resulting in or as a consequence of a disruption in the skin's integrity. This article covers the presentation, diagnosis, and treatment of the more common bacterial infections. The infections presented herein include impetigo, ecthyma, folliculitis, carbuncles/furuncles, cellulitis, toxic shock syndrome, and ecthyma gangrenosum. Once a diagnosis is made, treatment is based on the culture and antibiotic sensitivities of the offending organisms.

Anti-Bacterial Agents↗
PubMed2001

Common viral and fungal skin infections.

Skin infections account for a significant portion of dermatologic diseases, often resulting in, or as a consequence of a disruption in the skin's integrity. This paper covers the presentation, diagnosis, and treatment of the more common viral and fungal skin infections. The viral infections presented in this paper include herpes simplex virus, herpes zoster, condyloma acuminata, and molluscum contagiosum. The fungal infections presented include tinea pedis, tinea cruris, tinea capitis, tinea unguium, tinea versicolor, and candidiasis. Once a diagnosis is made, treatment with appropriate antifungal, antiviral, destructive, or immune modifying therapies can be instituted.

Candidiasis, Cutaneous↗
PubMed1999

Incorporating palliative care into critical care education: principles, challenges, and opportunities.

OBJECTIVE: To identify the goals and methods for medical education about end-of-life care in the intensive care unit (ICU). DATA SOURCES AND STUDY SELECTION: A status report on palliative care, a summary report of recent research on palliative care education, articles in the medical literature on end-of-life care and critical care, and expert opinion were considered. DATA EXTRACTION: A working group, including specialists in critical care, palliative care, medical ethics, consumer advocacy, and communications, was convened at the "Medical Education for Care Near the End of Life National Consensus Conference." A modified nominal group process was used to develop a consensus. DATA SYNTHESIS: In the ICU, life and death decisions are often made in a crisis mode or in the face of uncertainty, and may necessitate the withholding and withdrawal of life-supporting technologies. Because critical illness often diminishes the capacity of patients to make decisions, clinicians must often make decisions in conjunction with surrogates, rather than with patients. Discontinuity of care can threaten trusting relationships, and cultural diversity can have a particularly powerful impact on choices for care. In the face of these realities, it is possible and appropriate to give compassionate palliative care to dying patients and their families in the ICU. CONCLUSIONS: Teaching care of the dying in the ICU should emphasize the following: a) the goals of care should guide the use of technology; b) understanding of prognostication and treatment withholding and withdrawal is essential; c) effective communication and trusting relationships are crucial to good care; d) cultural differences should be acknowledged and respected; and e) the delivery of excellent palliative care is appropriate and necessary when patients die in the ICU.

Attitude to Death↗
PubMed1995

A comparison of diagnosis, evaluation, and treatment of patients with dermatologic disorders.

BACKGROUND: Managed care in the American health care system may limit access to health care specialists. OBJECTIVE: We assessed primary care providers' abilities at diagnosing and treating patients with a previously undiagnosed skin disorder. METHODS: Patients with previously undiagnosed skin disorders were seen and examined sequentially by three groups of physicians: (1) internal medicine residents, (2) board-certified internal medicine attending physicians and (3) dermatology faculty. The internal medicine residents and attending physicians' diagnoses were compared with the dermatologists'. Appropriateness of therapy ordered by the internal medicine residents and attending physicians was assessed. RESULTS: Medical residents' diagnoses were correct in 43% of the patients whereas the attending physicians diagnosed 52% of cases correctly. Attending physicians and residents frequently ordered therapy inappropriate for the patient's diagnosis. Internal medicine residents and attending physicians were more likely to order skin biopsies than dermatologists. CONCLUSIONS: Our results confirm earlier studies that nondermatologists perform poorly in the diagnosis and treatment of skin disease. Primary care providers should receive more training in dermatology, or dermatologists should be permitted to act as primary caregivers to patients with skin disease.

Adult↗
PubMed1995

Treatment of psoriasis: role of calcipotriene.

Psoriasis, a common skin disorder, affects over 1 percent of the population of the United States. The majority of these patients have limited disease that can be managed with topical therapy. Topical treatment includes corticosteroids, tar, anthralin and keratolytic agents. Calcipotriene, a new topical treatment for psoriasis of mild to moderate severity, is a vitamin D derivative that inhibits epidermal cell proliferation in vitro. Treatment with calcipotriene results in decreased redness, scaling and thickness of the plaque. Calcipotriene is comparable to mid-potency topical corticosteroids in efficacy, but it does not cause skin atrophy and apparently does not lead to tachyphylaxis. Irritant dermatitis is a common side effect of calcipotriene, especially when it is applied to the face. Careful patient monitoring is recommended because alterations in calcium metabolism have been reported to occur with use of calcipotriene.

Calcitriol↗
PubMed1994

Inappropriate use of oxygen: loss of a valuable healthcare resource.

Oxygen (O2) use is well established in hospitalized patients with hypoxemia. However, its value in patients without hypoxemia is not well documented. The authors conducted a retrospective study to evaluate the excess use of O2 and the resulting loss of resources. They established criteria for O2 use by faculty consensus. Ninety-six patients (102 admissions) receiving O2 between August and October 1991 were identified. Principal discharge diagnoses included cardiac diseases (37%), pulmonary diseases (26.5%), and miscellaneous (36.5%). Cumulative oxygen use was 9,742 hours. Appropriate O2 amounted to 3,272 hours (34%), and inappropriate O2 use was 6,470 hours (66%). The billing for O2 use was $38,468, of which $25,880 constituted inappropriate use. In 1991, there were 7,743 admissions, with oxygen charges of $1.06 million. Extrapolation of the data shows billing for inappropriate oxygen was $697,000. The authors conclude that inappropriate use of oxygen results in significant loss of resources. Educational efforts to decrease this loss and evaluate its impact on patient outcome is needed.

Adolescent↗
PubMed1986

Computer-assisted determination of protein concentrations from dye-binding and bicinchoninic acid protein assays performed in microtiter plates.

The bicinchoninic acid protein assay was scaled down to operate in the wells of microtiter plates. The total volume of the assay was reduced to 210 microliters and required only 10 microliters of sample per assay. The assay can be rapidly performed and then read with a plate reader. The analysis of the data was performed with a microcomputer interfaced with the reader. A computer program was developed to analyze the data from the bicinchoninic acid assay as well as the dye-binding assay at either the high or low protein concentration ranges. Based upon the absorbance values of the standards, the program computed a linear regression formula which was then used to calculate the concentrations of the sample proteins. A series of assays performed using bovine serum albumin, alpha-chymotrypsin and gamma globulin demonstrated that the scaled down bicinchoninic acid assay produced linear absorption versus concentration data with average correlation coefficients between 0.9967 and 0.9940 at the high and low concentration ranges respectively. The protein-to-protein variation and proper selection of either protein assay based upon the presence of interfering materials was considered.

Adult↗
PubMed1986

Pregnancy during residency.

To identify possible barriers to women physicians who wish to combine parenting with medical careers, we studied 56 of 64 pregnancies from the past 10 years in 63 of 66 Harvard-affiliated residency programs. Pregnancies during residency were common (one in eight married women in 1983) and were usually planned (77 percent). Most institutions were unprepared for pregnancies among members of the house staff; four fifths of the programs had no maternity-leave policy. No one quit a residency program because of pregnancy, and pregnancy rarely affected achievement of board certification. Whether the pregnant women found pregnancy during residency a "pleasant" experience was determined largely by whether the program director was supportive, whether the issue of pregnancy was openly discussed within the program, and whether the woman was permitted to return to work on a part-time basis for the first weeks after maternity leave. We conclude that pregnancy within residency programs should be expected and planned for and that if proper arrangements are made, it need not be a major problem for either the training program or the pregnant resident.

Attitude of Health Personnel↗
PubMed1975

Preparation of a modified glucose oxidase reagent for the polarographic determinationof glucose with the Beckman "glucose analyzer".

In this modification, glucose oxidase, 140-180 U/ml, is dissolved in acetate buffer (pH 6):ethanol (96%):glycerol (80:10:10 by vol). Iodine and molybdate are used as catalysts, formaldehyde and mercuric iodide as preservatives, and octanol as an antifoaming agent. The reagent is suitable for use in the Beckman "Glucose Analyzer", it is stable at room temperature for at least six months, it is sensitive, it has a lubricating effect, and its cost is less than a fifth as much as the "Certified" Beckman reagent. It is not suitable for the measurement of glucose in samples containing maltose, cellobiose, gentiobiose, starch, and glycogen.

Body Fluids↗